title: Ultrasound-guided perineural steroid injection to treat intractable pain due to sciatic nerve injury.
abstract: OBJECTIVE
  Sciatic neuropathy is a rare but serious complication of cardiac surgery. Neuropathic pain following nerve injury can be severely debilitating and largely resistant to treatment. We present a case of this complication where ultrasound-guided perineural steroid injection at the site of the sciatic nerve injury provided excellent pain relief and facilitated subsequent rehabilitation.
  
  
  METHODS
  A 17-yr-old boy developed bilateral sciatic neuropathy after a nine-hour cardiac surgical procedure in the supine position, resulting in debilitating dysesthesia refractory to neuropathic pain therapies and leading to severe functional limitation. With magnetic resonance imaging of the lower extremities, the location of the lesion was determined to be from the level of the superior gemellus to the level of the quadratus femoris. An ultrasound-guided injection of triamcinolone 20 mg and lidocaine 40 mg around both sciatic nerves at the level of the lesion was administered two months after the surgery, and the pain score (rated on a scale 0-10) at rest decreased from 9-10 to 1 two weeks after the injection.
  
  
  CONCLUSIONS
  There are a limited number of reports in the literature on sciatic nerve injuries associated with cardiac surgery. This case illustrates the efficacy of ultrasound-guided steroid injection around sciatic nerves at the level of superior gemellus in treating our patient's neuropathic pain.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan, ROC.
authors.forename: Jia-Chi
authors.initials: JC
authors.lastname: Wang
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Chiou
authors.forename: Jen-Her
authors.initials: JH
authors.lastname: Lu
authors.forename: Yung-Cheng
authors.initials: YC
authors.lastname: Hsu
authors.forename: Rai-chi
authors.initials: RC
authors.lastname: Chan
authors.forename: Tsui-Fen
authors.initials: TF
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D009407:Nerve Block / Q000379:methods; D012584:Sciatic Nerve / Q000293:injuries*; D020426:Sciatic Neuropathy / Q000188:drug therapy* / Q000209:etiology; D014221:Triamcinolone / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D014221:Triamcinolone; D008012:Lidocaine